Transcript Business Plan FY 2006

Electronic Medical Records:
Retrieval and Underwriting
Texas Medical Dictionary
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Artery.............................. The study of paintings
Bacteria.......................... Back door to the cafeteria
Barium............................. What doctors do when patients die
Benign............................ What you be, after you be eight
Caesarean Section......... A neighborhood in Rome
Cat scan......................... Searching for Kitty
Cauterize........................ Made eye contact with her
Colic................................. A sheep dog
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Texas Medical Dictionary
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Coma.............................. A punctuation mark
Dilate............................... To live long
Enema............................. Not a friend
Fester.............................. Quicker than someone else
Fibula............................... A small lie
Impotent..........................Distinguished, well know
Labor Pain....................... Getting hurt at work
Medical Staff.................... A Doctor's cane
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Texas Medical Dictionary
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Morbid..............................A higher offer
Nitrates.............................Cheaper than day rates
Node................................ I knew it
Outpatient....................... A person who has fainted
Pelvis.............................. Second cousin to Elvis
Post Operative............... A letter carrier
Recovery Room............. Place to do upholstery
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Texas Medical Dictionary
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Rectum...........................Dern near killed him
Secretion........................Hiding something
Seizure.......................... Roman emperor
Tablet............................ A small table
Terminal Illness............. Getting sick at the airport
Tumor........................... One plus one more
Urine............................. Opposite of you're out
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Sources
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ACORD
MIB
PilotFish
Copy Services
Buyers Guide White Paper
Masters candidates in hospital administration Baylor University
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Today’s Presentation
 Introduction to EMR / EHR - glossary of terms
 Who’s driving HER adoption?
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What’s Law Got To Do With It?
Healthcare
Business - $$$ (who makes / saves money?)
Government’s role
Vendors
 How will it affect me? Life insurance underwriting?
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Glossary
 ARRA – American Recovery and Reinvestment Act. Among
many other initiatives, the law provides incentive payments
for healthcare providers that use EMRs. Incentive payments
begin in 2011 and will gradually decrease until 2014 – after
which, providers not using EMRs will be penalized.
 EMR – Electronic Medical Records. Computerized system that
stores notes, prescriptions, and other medical information for
a patient in an electronic format rather than on paper. EMRs
make searching for, retrieving, and sharing patient data
more user-friendly and efficient. A federal mandate, called
the Health Information Technology for Economic and Clinical
Health Act (HITECH) and introduced in 2009, requires all
medical practices and hospitals to adopt the EMR system by
2014.
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Glossary
 EHR – Electronic Health Record. Electronic Health Record
attempts to promote a more holistic view of patient records
where continuum of care is the key aspect, allowing access
to medical information by multiple stakeholders. Many
healthcare systems possess pieces of the Electronic Health
Record such as computerized physician order entry or
electronic medical records within one point of care.
However, only 1.5% of hospitals in the United States actually
utilize a fully integrated Electronic Health Record
 CCR – Continuity of Care Record. A new document standard
being developed for EMR software vendors to allow patient
data to be easily moved from on eMR vendor in the same
format.
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Glossary
 CCDIT – Certification Commission for Healthcare Information
Technology. The organization that certifies healthcare IT
products, including the certification to qualify EMR software
for government incentive payments.
 CDR – Clinical Data Repository. A database that
consolidates data from a variety of healthcare providers to
present a single health record for a patient.
 REC – Regional Extension Center. Government funded
system that offers technical assistance, guidance, and
information on best practices to support and accelerate
health care providers’ efforts to become meaningful users of
EMR.
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The Drivers
 Healthcare providers - improved healthcare - thorough, fast
access to patient records
 Studies
» John Hopkins University study published in 2009
reviewed 41 hospitals. Those using EMR
 15% lower death rate
 16% fewer complications
 Lower operating costs
» Arizona State University study in 2010 found that
hospitals using latest EMR technology reduced
emergency room wait by 22% compared to old or no
EMR
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The Drivers
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Minimize dangerous errors / drug interactions –
handwriting
» Automatically alerts doctors of patient allergies or
dangerous drug interactions
» National Academy of Sciences’ Institute of Medicine
determined sloppy handwriting led to 7,000 deaths
every year in the United States.
More focus on patients, less on paperwork
Automatic wellness reminders supports scheduling
important tests, exams – treatments screenings and
immunizations
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The Drivers
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Data mining – patient notification of drug recall, warnings,
etc .
Software assisted diagnosis and treatment suggestions
Improved customer service when patients call with
questions. Records are immediately available. Case study
in a large practice in the Midwest reduced their patient
responses from fifteen to five minutes.
Differential diagnosis
Association of disease and treatment
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The Drivers
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Sharing of data
» Communicating with other organizations doctors,
hospitals, labs, physical therapists, pharmacists, etc.
» Referrals – efficiently generate referral letterandattach
patient records
» Prescriptions – electronic or autofax prescriptions to
pharmacist
» Printing of EMR for chart requests (paving the
cowpath)
» EDI – sharing of actual electronic data
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The Drivers
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Summary
» Better care
» Safer environment for patients
» More efficiency
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The Drivers
 Reduce cost
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Increased efficiency
Less wasted time searching for missing charts
Lower operation costs
Better quality of care
Data mining
Predictive diagnosis
Scoring
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The Drivers
 Government regulations
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American Recovery and Reinvestment Act (ARRA) of
2009
» $45 billion to fund EMR adoption
» Initial payments begin in 2011
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The Drivers
» Incentives for early adopters through 2014
 Increased Medicaid and Medicare reimbursements
– Hospitals
– Up to $2 million in the first year
– More in subsequent years depending on size
and number of patients
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The Drivers
– Doctors
– $44,000 in Medicare payments of a five year
period, or
– $63,750 over six years in Medicaid payments
(30% of patients)
– These payments are given to individual doctors,
so different doctors in the same practice can
each get payments if eligible
– Must start in 2011 or 2012 to receive maximum
– Must demonstrate meaningful usage by Centers
of Medicare and Medicaid Services by 2015.
– Software must be certified by CCHIT
Certification Commission for Healthcare
Information Technology www.cchit.org
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The Drivers
» Penalties beginning 2015 - doctors and hospitals alike
without meaningful use by 2015 will receive decreased
Medicaid and Medicare reimbursements
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1% in 2015
2% in 2016
3% in 2017
3% - 5% thereafter
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The Drivers
 Vendors
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210 different providers of EMR solutions
» McKesson
» General Electric
» Cerner
» Epic
» Allscripts/Eclipsys
Large vendors
Certification – integration and connectivity standards
Security
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Obstacles
 The New England Journal of Medicine has identified five
major perceived barriers to adoption of Electronic Health
Records: inadequate capital for purchase, unclear return on
equity, maintenance costs, physicians’ resistance, and
inadequate IT staff.
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Obstacles
 Cost
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Only 20% of doctors and 10% of hospitals are currently
using EMR.
Short term increased cost
» Systems
» Software
Lost efficiencies due to training and learning curve
Training – doctors, nurses, technicians and aids have not
been trained in these systems. Costs associated with
training cannot be overlooked.
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Obstacles
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Inadequate technical staff – many times contractors must
be hired to support installations.
Conversion of existing paper documents
Long term yet to be determined
CCHIT – Certification Commission for Healthcare
Information Technology
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Obstacles
 Physician resistance
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With the advent of the Electronic Health Record,
physicians are being asked to completely change the
way that they practice medicine.
New EHR systems are forcing physicians to use a
computer throughout the entire continuum of care
forcing the alteration of many habitual processes.
Data must be input into the system rather than through
verbal documentation.
Each particular EHR vendor has its own unique
terminology for navigation, making the learning curve
even steeper.
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Obstacles
 Security
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Privacy leaks and data breaches
Access to large quantities of patient history information
Data could be mined
Strict access policies must be written and strictly enforced
including password protection, copying of records to
external media or portable storage device
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Effects on Record Retrieval and Underwriting
 Sharing of EMR data
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Current model requires printing to paper or other
electronic image format (pdf, tif, jpg) and sending via
mail, fax or other electronic means
Data format standards
» Health Level 7 (HL7) is an international community of
healthcare subject matter experts and information
scientists collaborating to create standards for the
exchange, management and integration of electronic
healthcare information.
 Headquartered in Ann Arbor, MI
 Archaic standards
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Effects on Record Retrieval and Underwriting
» Clinical Data Repository – new document standard
being developed for EMR software vendors to allow
patient data to be easily moved from one EMR vendor
to another in the same format
 New XML standard CCR – needs work, cooperation
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Build once compliant with HL7 or CCR standard, integrate
with many across vendor systems and healthcare
providers
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Conclusion
 Great but how can we benefit without all the downside?
 Some of these benefits include: immediate computerized
decision support, improved patient continuum of care, and
elimination of paper charts. However, these benefits may
pale in comparison to the overall cost of implementing and
maintaining the system. Installation costs of the actual
system, training costs, and opportunity costs such as lost
productivity from staff and clinicians make up significant
costs of implementation.
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